No abstract available.
Gastrectomy*

We report a case of mucinous adenocarcinoma arising in the perianal soft tissue in association with chronic fistula-in-ano in a 43-year-old man who had a relapse of perianal pain and bloody discharge after six years of defaulted follow-up. He underwent magnetic resonance (MR) and computed tomography imaging with correct identification of the disease entity on imaging. Mesh-like septations and an enhancing solid component with high diffusion-weighted imaging (DWI) and intermediate apparent diffusion coefficient signals were observed. He underwent abdominoperineal resection of the tumour but succumbed due to postoperative complications. Literature on the MR imaging features of this tumour remains scarce. We highlight the MR imaging features, including those seen on DWI, which were useful in making the correct diagnosis. Though uncommon, this would be an important condition to recognise since assessment of fistula-in-ano by MR imaging is considered to be the standard of care in current clinical practice. The clinical features of this entity are also briefly discussed.
Adenocarcinoma, Mucinous ; complications ; diagnosis ; Adult ; Anus Neoplasms ; complications ; diagnosis ; Chronic Disease ; Diagnosis, Differential ; Diffusion Magnetic Resonance Imaging ; Humans ; Male ; Rectal Fistula ; complications ; diagnosis ; Tomography, X-Ray Computed

Aged ; Antitubercular Agents ; therapeutic use ; Cholangiocarcinoma ; diagnosis ; pathology ; Diagnosis, Differential ; Humans ; Magnetic Resonance Imaging ; Male ; Tuberculosis, Hepatic ; diagnosis ; drug therapy ; pathology

Renal angiomyolipomas are benign neoplasms composed of varying amounts of adipose tissue, smooth muscles and blood vessels. They typically contain macroscopic fat, which is seen as negative attenuation on computed tomography. Calcification and scarring is rarely seen in renal angiomyolipomas. We report the case of a 40-year-old man who was found to have a renal angiomyolipoma with a central stellate scar and focal calcification. The lesion was initially misdiagnosed as a calyceal calculus.
Adipose Tissue ; diagnostic imaging ; pathology ; Adult ; Angiomyolipoma ; diagnosis ; surgery ; Biopsy, Needle ; Calcinosis ; diagnostic imaging ; pathology ; Diagnosis, Differential ; Humans ; Immunohistochemistry ; Kidney Calculi ; diagnosis ; surgery ; Kidney Calices ; diagnostic imaging ; pathology ; Kidney Neoplasms ; diagnosis ; surgery ; Low Back Pain ; diagnosis ; etiology ; Male ; Risk Assessment ; Tomography, X-Ray Computed ; methods ; Treatment Outcome ; Urography ; methods

Leiomyomatosis peritonealis disseminata is usually asymptomatic or mimics widespread malignancy; acute presentation is rare. We describe a patient with right iliac fossa and lower abdominal pain. Two masses were detected via computed tomography, but at surgery, one of these implanted leiomyomas had undergone acute omental torsion. This case illustrates a rare complication of omental leiomyoma torsion clinically mimicking acute appendicitis.
Adult ; Diagnosis, Differential ; Female ; Humans ; Leiomyomatosis ; complications ; diagnosis ; Omentum ; pathology ; Peritoneal Neoplasms ; complications ; diagnosis ; Tomography Scanners, X-Ray Computed ; Torsion Abnormality ; etiology ; surgery

OBJECTIVE: Suicide is a significant public health concern worldwide. Social media data have a potential role in identifying high suicide risk individuals and also in predicting suicide rate at the population level. In this study, we report an advanced daily suicide prediction model using social media data combined with economic/meteorological variables along with observed suicide data lagged by 1 week. METHODS: The social media data were drawn from weblog posts. We examined a total of 10,035 social media keywords for suicide prediction. We made predictions of national suicide numbers 7 days in advance daily for 2 years, based on a daily moving 5-year prediction modeling period. RESULTS: Our model predicted the likely range of daily national suicide numbers with 82.9% accuracy. Among the social media variables, words denoting economic issues and mood status showed high predictive strength. Observed number of suicides one week previously, recent celebrity suicide, and day of week followed by stock index, consumer price index, and sunlight duration 7 days before the target date were notable predictors along with the social media variables. CONCLUSION: These results strengthen the case for social media data to supplement classical social/economic/climatic data in forecasting national suicide events.
Forecasting ; Public Health ; Social Media* ; Suicide* ; Sunlight

Background: and Purpose Paroxysmal atrial fibrillation (PAF) underlying acute stroke frequently evades detection by standard practice, considered to be a combination of routine electrocardiogram (ECG) monitoring, and 24-hour Holter recordings. We hypothesized that nurse-led in-hospital intermittent monitoring approach would increase PAF detection rate. Methods: We recruited patients hospitalised for stroke/transient ischemic attack, without history of atrial fibrillation (AF), in a prospective multi-centre observational study. Patients were monitored using a smartphone-enabled handheld ECG (iECG) during routine nursing observations, and underwent 24-hour Holter monitoring according to local practice. The primary outcome was comparison of AF detection by nurse-led iECG versus Holter monitoring in patients who received both tests: secondary outcome was oral anticoagulant commencement at 3-month following PAF detection. Results: One thousand and seventy-nine patients underwent iECG monitoring: 294 had iECG and Holter monitoring. AF was detected in 25/294 (8.5%) by iECG, and 8/294 (2.8%) by 24-hour Holter recordings (P<0.001). Median duration from stroke onset to AF detection for iECG was 3 days (interquartile range [IQR], 2 to 6) compared with 7 days (IQR, 6 to 10) for Holter recordings (P=0.02). Of 25 patients with AF detected by iECG, 11 were commenced on oral anticoagulant, compared to 5/8 for Holter. AF was detected in 8.8% (69/785 patients) who underwent iECG recordings only (P=0.8 vs. those who had both iECG and 24-hour Holter). Conclusions Nurse-led in-hospital iECG surveillance after stroke is feasible and effective and detects more PAF earlier and more frequently than routine 24-hour Holter recordings. Screening with iECG could be incorporated into routine post-stroke nursing observations to increase diagnosis of PAF, and facilitate institution of guideline-recommended anticoagulation.

BACKGROUND: Professional affiliation between medical centers and professional sports teams can be mutually beneficial in the provision of healthcare and marketing strategy. Anecdotal evidence suggests a link between trauma volume and sporting events; however, there is limited data. This study aims to characterize the incidence of operative hand and facial trauma during professional baseball home games. METHODS: A retrospective review of surgical cases for traumatic hand or facial injuries at a level 1 center between 1999 and 2012 was performed. Demographic information including date of injury, admission status, and operative repair were collected. Patients were grouped based on whether their trauma occurred on the date of a home game. RESULTS: Operative hand and facial trauma occurred at a rate of 33.4 injuries per 100 days with home games, compared to 22.2 injuries per 100 days (incidence rate ratios, 1.50; 95% confidence interval, 1.34–1.69). When home games were played, patients were more likely to present as a result of motorcycle accidents (3.1% vs. 1.5%; P=0.04) or bicycle accidents (5.0% vs. 2.6%; P=0.01). Other mechanisms of trauma were not statistically different. There was an increase incidence of injuries during home games in August; weekly variability showed an increased incidence during the weekends. CONCLUSIONS: There was an increased rate of operative hand and facial injuries on dates with professional home games. The incidence of injuries during home games was higher in the late summer and on the weekends. Further analysis may allow improved resource allocation and strategies for injury prevention and treatment.
Baseball ; Delivery of Health Care ; Facial Injuries ; Hand Injuries ; Hand ; Humans ; Incidence ; Marketing ; Motorcycles ; Resource Allocation ; Retrospective Studies ; Sports ; Trauma Centers

INTRODUCTION: Idiopathic granulomatous mastitis (IGM) is a rare, benign, chronic breast condition that can cause repeated abscesses or mass formation in bilateral breasts. The condition can severely impact the quality of life of affected women. This study aims to evaluate effective treatment modalities, as well as understand the demographics and clinical presentation of patients with IGM. METHODS: An 11-year retrospective review was performed of patients diagnosed with IGM from 1 January 2008 to 31 December 2018 at a tertiary breast unit. RESULTS: A total of 77 patients were included in the study. The median age at presentation was 36 years old. IGM presented most commonly as a breast lump (98.1%). The median number of flares was 2 (1-12). Of the 77 patients, 68.8% (53) were treated with antibiotics, 50.6% (39) with steroids, and 44.2% (34) underwent surgery, in the course of their IGM treatment. Forty-five (59.2%) of the 76 patients with IGM required a multimodal treatment approach to achieve remission. There was no significant difference in the number of flares no matter the initial treatment ( CONCLUSION IGM is a clinical diagnosis. It is a rare, relapsing breast inflammatory condition that affects young females with no superior treatment modality. Smoking is associated with higher number of flares of IGM and should be discouraged in IGM patients.
Adult ; Anti-Bacterial Agents/therapeutic use* ; Female ; Granulomatous Mastitis/therapy* ; Humans ; Quality of Life ; Retrospective Studies ; Treatment Outcome

Sclerosing angiomatoid nodular transformation (SANT) is an exceedingly rare, benign and proliferative vascular lesion that arises from the splenic red pulp. It is often an incidental finding on imaging. The diagnosis of SANT is confirmed via histopathological examination of the resected spleen. Herein, we present a case of SANT and describe its typical imaging characteristics. An asymptomatic 39-year-old man was found to have a 3.1 cm × 2.7 cm × 2.3 cm hypoechoic splenic lesion during abdominal ultrasonography, which was performed to investigate his elevated gamma-glutamyl transpeptidase and alanine transaminase levels. Contrast-enhanced computed tomography suggested a vascular splenic lesion, while magnetic resonance imaging demonstrated features consistent with SANT. In view of the increasing size of the lesion on follow-up imaging, the patient elected for splenectomy. Histopathological examination confirmed SANT, and the lesion was completely resected by laparoscopic splenectomy.
Adult ; Alanine Transaminase ; blood ; Cell Proliferation ; Contrast Media ; chemistry ; Disease Progression ; Humans ; Image Processing, Computer-Assisted ; methods ; Incidental Findings ; Laparoscopy ; Magnetic Resonance Imaging ; Male ; Multimodal Imaging ; methods ; Spleen ; diagnostic imaging ; Splenectomy ; Splenic Diseases ; diagnostic imaging ; Tomography, X-Ray Computed ; Ultrasonography ; gamma-Glutamyltransferase ; blood